izben c. williams, md, mph lecturer. lecture # 11 psychiatric disorders of children

BEHAVIORAL SCIENCE

IzBen C. Williams, MD, MPHLecturer

Lecture # 11

PSYCHIATRIC DISORDERS OF CHILDREN

Psychiatric Disorders in Children

Child and adolescent psychiatry is the study and treatment of the mental, developmental, and behavioral problems of childhood

An understanding of standard childhood psychological development is essential to the understanding of childhood psychopathology


Childhood Psychopathology (an overview)Most disorders are more common in boys Psychopathology is usually the result of

chronic, maladaptive interactions between child and environment, often combined with some genetic, physiologic, or temperamental propensity (bio-psycho-social influences) towards developing a mental illness

Misbehavior may be the result of the parents’ conscious or unconscious prompting


Feeding and eating disorders of infancy and childhood Pica: persistent eating of non-food

productsRumination disorder: purposeful

expulsion and re-chewing of previously ingested food

Failure to thrive: feeding disorder of infancy or early childhood


Pervasive developmental disorders of childhood (1)Autistic spectrum disorders (autism

disorder and Asperger disorder)Rett disorder, Childhood disintegrative disorder


Pervasive developmental disorders of childhood (2)These disorders are characterized by

failure to acquire, or the early loss of, social skills and difficulties with language resulting in lifelong problems in social and occupational functioning

They are not reversible


Autistic DisorderAutistic disorder is an illness in which the

child is: Is relatively unresponsive to human

beings Demonstrates bizarre responses to his

environment Has unusual language development


Autistic Disorder Characteristics include:

Severe problems with communication (despite normal hearing)

Significant problems with social relationships Repetitive behavior (eg spinning, self-injury) Subnormal intelligence in many (26% to 75%) Unusual abilities in some children (savant

skills)


Autistic DisorderAutism is also a symptom of several

disorders (eg schizophrenia)As a symptom, autism refers to a

preoccupation with the internal world of the individual to the exclusion of external reality

Autistic children treat other individuals indifferently, almost as though they were inanimate objects

Social development is invariably abnormal


Autistic Disorder characteristics:Usually begins before age 3 yrsOccurs in about 17 per 10,000 childrenFive times more common in boysAutism is also a symptom of several

disorders (eg schizophrenia)As a symptom autism refers to a

preoccupation with the internal world of the individual to the exclusion of external reality


Asperger DisorderAsperger disorder is a mild form of autism

involvingSignificant problems forming social

relationshipsRepetitive behavior and intense interest in

obscure subjects In contrast to autistic disorder, in Asperger’s

there’s normal cognitive development and little or no developmental language delay but conversational language skills are impaired


Rett disorderClinical characteristics:

Diminished social, verbal, and cognitive development after up to four years of normal functioning

Occurrence only in girls (Rett disorder is X-linked and affected males die before birth)

Stereotyped hand wringing movements, ataxia

Mental retardation, breathing problems


Elimination DisordersEnuresis: child continues to urinate at

inappropriate times and places, past the time after which he should have ceased May be primary or secondary

Etiology: Organic disorders, Psychological factors

Treatment: Usually self limiting Medication Tricyclic antidepressant imipramine Treat any underlying stress


Elimination DisordersEncopresis: Fecal incontinence past the

period when bowel control should have been established.

Most encopresis is unconscious and involuntary; only occasionally does it occur deliberately.

May be primary of secondary


Elimination DisordersEtiology of Encopresis:

Organic disordersPsychological Factors

Unresolved anger at parentRegressive wishesPsychotic symptomsWhen autonomy and control battles focus

on toilet training……Treatment: Appropriate to cause


Thumb suckingMore common in girls than boysIs normal at traditional periods in child’s

life (eg at bedtime, at times of separation from the parent)

If it persists after age 3yrs it can cause changes in dentition

Exploration of child’s relationship with parent is usually indicated.

In older child behavior modification may be useful (eg: where child is insecure or withdrawn)


Masturbation Childhood masturbation involves general

manipulation and fondling. Parents may complain

It is a universal behavior and not restricted to children (as is well known).

An open attitude by physician is importantAny notion that masturbation may cause

growth retardation, mental retardation, or any other adverse physical consequences should be dispelled


Masturbation Masturbation occurs in all children.It can develop before age 1 year. During

the oedipal period (3-6yys) there may be heightened genital focus.

Continuous masturbation may be a sign of severe under-stimulation (psychological), environmental deprivation, excessive sexual stimulation, or sexual abuse.


Tourette Disorder:Clinical data. Tourette disorder consists of

recurrent, involuntary, purposeless, motor movements accompanied by verbal tics. There may be coprolalia, involuntary swearing, barking and grunting).

Psychological stress exacerbates the symptoms, but the cause, although unknown, is probably organic

ADHD & OCD occur with increased frequency in these patients


Tourette DisorderEpidemiology:

More common in boys, Onset before age 21Occurs in all socioeconomic classes

Treatment:PsychotherapyEducationMedical treatment


Attention Deficit Hyperactivity Disorder

Key symptoms of ADHD include:A short attention span Difficulty concentratingImpulsivityDistractibilityExcitability and Hyperactivity



Three types recognized:i. ADHD predominantly inattentiveii. ADHD predominantly hyperactive –

impulsiveiii. ADHD combined

Seen more often in boys


Attention Deficit Hyperactivity Disorder Etiology:

i. Medication eg: sedative hypnotics (paradoxical)

ii. Depression. Sad feelings …..hyperactivityiii. Anxiety iv. Constitutional hyperactivity (from birth)v. Intolerant parent, teacher or supervisorvi. Severe CNS diseasevii. Specific learning disabilities….etc.



Treatment: i. Medication: stimulants, clonidine,

antidepressantsii. Diet eg decrease sugar intakeiii. Behavior modification programsiv. Environmental engineering

.

PROBLEMS OF

ADOLESCENTS


Problems of adolescentsA. Identity DisturbancesB. Adult sexual developmentC. SeparationD. Treatment


Problems of adolescentsA. Identity Disturbances

Adolescents struggle to achieve a stable identity. Certain problems result when this aspect of development breaks down. Identity diffusion Peer-related disorders Problems with successfully resolving this

developmental task my contribute to the development of identity disorder, narcissistic and borderline personality disorders


Problems of adolescentsB. Adult sexual development

Homosexual behaviors: found commonly in early adolescence. However, when they persist through early adulthood it usually represents true homosexual preference

Paraphilias: experiences of intense sexual arousal to atypical objects, situations, or individuals.

PregnancySexually transmitted diseases


Problems of adolescentsC. Separation: Adolescents negotiate their

emancipation from family and redefine the parent-child and sibling roles and boundaries

Difficulty with emancipation Schizophrenia Anorexia Depression

Mobilization of aggression (emancipation ritual)Incestuosity (can develop to prevent

emancipation)


Problems of adolescentsD. Treatment: Special problems in

psychotherapy with adolescents Labile allegiances good/bad from day to

dayLabile moods hormonal and psyc

turbulenceCommunication difficulties (many

adolescents communicate by means of their behavior)

Overprotective parents

Vignettes –Personality Disorders

Personality Disordershttps://

www.youtube.com/watch?v=ijMPEgMxrashttps://

www.youtube.com/watch?v=q1lClgIfA9Uhttps://

www.youtube.com/watch?v=xdPuSnP8YY8

https://www.youtube.com/watch?v=ijMPEgMxras

https://www.youtube.com/watch?v=ijMPEgMxras

https://www.youtube.com/watch?v=q1lClgIfA9U

https://www.youtube.com/watch?v=q1lClgIfA9U

https://www.youtube.com/watch?v=xdPuSnP8YY8

https://www.youtube.com/watch?v=xdPuSnP8YY8

Vignettes Psychiatric Disorders of children

Autism Spectrum Disorderhttps://

www.youtube.com/watch?v=0Pp8jcQ97pYhttps://

www.youtube.com/watch?v=YtvP5A5OHpTourette Disorder

https://www.youtube.com/watch?v=JOfeW9qsNV8

https://www.youtube.com/watch?v=jYRa-fpNonY

ADHDhttps://

www.youtube.com/watch?v=RMaCE5RT54c

https://www.youtube.com/watch?v=xbPbBCD1lTw

https://www.youtube.com/watch?v=0Pp8jcQ97pY

https://www.youtube.com/watch?v=0Pp8jcQ97pY

https://www.youtube.com/watch?v=YtvP5A5OHp

https://www.youtube.com/watch?v=YtvP5A5OHp





https://www.youtube.com/watch?v=RMaCE5RT54c





Vignettes Psychiatric Disorders of children

ADHDhttps://www.youtube.com/watch?v=-

mqpdomdnH4

https://www.youtube.com/watch?v=-mqpdomdnH4

https://www.youtube.com/watch?v=-mqpdomdnH4

izben c. williams, md, mph lecturer. lecture # 11 psychiatric disorders of children

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